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Perineal wound reconstruction using a perineal colostomy (PC) has given acceptable functional results and shortens the time of perineal wound healing following abdominoperineal resection (APR). This work used a standardized questionnaire aimed at comparing long-term quality of life inpatients with either an iliac colostomy (IC) after APR or a PC plus antegrade enemas via a neoappendicostomy.The quality of life in 20 consecutive patients having undergone PC after APR at our institution was compared with that of 22 members of a stoma-patient association who underwent APR + IC at other institutions. Patients were matched for age, delay from surgery and use of radiotherapy. Quality of life was assessed by QLQ-C30 and QLQ-CR38 questionnaires.Among 27 explored domains of quality of life, three were significantly higher in the PC group: global physical status, social activities and weight loss. For men, trust in the future was significantly higher in the PC group while for the women, fatigue was significantly less. Other scores tended to be higher in the PC group without reaching statistical significance.Perineal reconstruction by means of PC after APR seems to offer a better long-term quality of life than IC in selected patients.